Nursing Elites

1. A 35-year-old woman presents with fatigue, weight gain, and cold intolerance. Laboratory tests reveal high TSH and low free T4 levels. What is the most likely diagnosis?

• A. Hypothyroidism
• B. Hyperthyroidism
• C. Thyroiditis
• D. Thyroid cancer

Correct answer: A

Rationale: The scenario describes a 35-year-old woman with symptoms of fatigue, weight gain, and cold intolerance along with high TSH and low free T4 levels. These findings are consistent with the diagnosis of hypothyroidism. In hypothyroidism, there is decreased thyroid hormone production leading to elevated TSH levels as the body tries to stimulate the thyroid to produce more hormone. The low free T4 levels indicate insufficient thyroid hormone in the blood, which can manifest as symptoms such as fatigue, weight gain, and cold intolerance.

2. A client with a history of diabetes mellitus presents with confusion, sweating, and palpitations. What should the nurse do first?

• A. Check the client's blood glucose level.
• B. Administer 10 units of insulin.
• C. Give the client a high-protein snack.
• D. Measure the client's blood pressure.

Correct answer: A

Rationale: The correct first action for a client presenting with confusion, sweating, and palpitations, suggestive of hypoglycemia, is to check the client's blood glucose level. This step helps to confirm if the symptoms are due to low blood sugar levels and guides appropriate interventions. Administering insulin without knowing the current blood glucose level can be dangerous and is not recommended as the initial step. Offering a high-protein snack may be necessary after confirming hypoglycemia, but checking the blood glucose level takes precedence. Measuring blood pressure is not the priority in this situation; addressing hypoglycemia is the immediate concern.

3. The patient has a calcium level of 12.1 mg/dL. Which nursing action should the nurse include on the care plan?

• A. Maintain the patient on bed rest.
• B. Auscultate lung sounds every 4 hours.
• C. Monitor for Trousseau's and Chvostek's signs.
• D. Encourage fluid intake up to 4000 mL every day.

Correct answer: D

Rationale: The correct action for the nurse to include on the care plan for a patient with a calcium level of 12.1 mg/dL is to encourage fluid intake up to 4000 mL every day. This is essential to decrease the risk for renal calculi associated with hypercalcemia. While bed rest is not necessary, ambulation is encouraged to help decrease the loss of calcium from the bone. Monitoring for Trousseau's and Chvostek's signs is more relevant when hypocalcemia is suspected. Auscultating lung sounds every shift is a routine assessment, not required every 4 hours unless there is a specific respiratory concern.

4. A patient with hypertension is prescribed lisinopril. What side effect should the nurse monitor for?

• A. Hyperkalemia
• B. Hypoglycemia
• C. Bradycardia
• D. Constipation

Correct answer: A

Rationale: When a patient is prescribed lisinopril, an ACE inhibitor, the nurse should monitor for hyperkalemia. Lisinopril can cause hyperkalemia by decreasing aldosterone secretion, which leads to potassium retention in the body. Hyperkalemia is a potential side effect of ACE inhibitors and should be closely monitored, as it can have serious consequences such as affecting cardiac function.

5. A 60-year-old male client is admitted to the hospital with the complaint of right knee pain for the past week. His right knee and calf are warm and edematous. He has a history of diabetes and arthritis. Which neurological assessment action should the nurse perform for this client?

• A. Glasgow Coma Scale
• B. Assess pulses, paresthesia, and paralysis distal to the right knee
• C. Assess pulses, paresthesia, and paralysis proximal to the right knee
• D. Optic nerve using an ophthalmoscope

Correct answer: B

Rationale: In this scenario, the nurse should assess pulses, paresthesia, and paralysis distal to the right knee to evaluate for neurovascular compromise. This assessment helps determine the perfusion and sensation of the lower extremity, which is crucial in identifying potential vascular or nerve damage that may be causing the client's symptoms.

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